[Secondary Angiosarcoma of the Breast after Breast-conserving Therapy]. / Das sekundäre Angiosarkom der Brust nach brusterhaltender Therapie.

BACKGROUND: Mammography for the detection of early stage breast cancer is widely established. Breast-conserving therapy followed by radiation therapy is the most common therapy for early stage breast cancer. Due to the increasing use of radiation therapy in breast cancer, secondary neoplasia are induced. The most common secondary neoplasia of the breast is the angiosarcoma. It occurs 4-7 years after radiation therapy. Genetic predisposition and a transformation of endothelial cells by radiation therapy are known to lead to angiosarcoma. OBJECTIVE: The present paper outlines a concept for treatment on the basis of the current literature and the experience of the authors. RESULTS AND CONCLUSION: Radical surgical resection of the tumour with a sufficient margin of safety is the treatment of choice for angiosarcoma. Tumour infiltration of the chest wall and other local structures are challenges for the surgeon performing a radical tumour resection. The replacement of the tissue is also demanding for the surgeon. After radiation therapy the reconstructive options are limited. Individual factors such as age, quality of local vessels and the patients demand for breast reconstruction should be considered. Although R0 resection is performed, the 5-year survival rates are 20-30%.

[Acute upper limb embolism in a severely burned patient]. / Akute Embolie der A. brachialis bei einem Schwerbrandverletzten.

Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days.